“LEAD­ERS MUST MAKE SENSE OF THESE THINGS”

Helen Be­van has spent 25 years over­see­ing change ini­tia­tives at Eng­land’s Na­tional Health Ser­vice, which serves more than 50 mil­lion pa­tients and em­ploys 1.2 mil­lion health care staffers. She spoke with HBR about the chal­lenges of pre­serv­ing the gains from one ini­tia­tive while launch­ing new ef­forts. Edited ex­cerpts fol­low.

Q: Why is it so hard to sus­tain an ini­tia­tive’s im­prove­ments?

A: It’s an is­sue of en­ergy. And when a new ini­tia­tive comes along, peo­ple ask, “What do we do with the old one?” Much of our work­force mod­els the be­hav­iour of se­nior lead­ers, and when those lead­ers shift their en­ergy to some­thing else, it’s hard to sus­tain things.

What dif­fer­en­ti­ates changes that stick?

Sus­tain­abil­ity starts at the be­gin­ning, in how we frame a project and what it means to the or­gan­i­sa­tion and our pur­pose. It’s the dif­fer­ence be­tween be­hav­ing like a buyer and be­hav­ing like an in­vestor. If we’re ask­ing doc­tors to get on board some­thing that’s un­der way, it’s al­ready too late. We need to get them in­vested in the project, and think­ing like own­ers, well be­fore it be­gins. When I look at the dif­fer­ence be­tween projects that are sus­tained and ones that aren’t, it of­ten has to do with tak­ing time at the be­gin­ning to set them up, frame them the right way, and get peo­ple in­vested.

Is this es­pe­cially hard in a health care set­ting, where ef­fi­cien­cies may seem to con­flict with qual­ity care?

Our pur­pose is health and well­ness. That’s what mo­ti­vates peo­ple in this sec­tor; they don’t come for the pay. If we can frame a project as re­lat­ing to things that re­ally mat­ter to the peo­ple who work here, they will con­nect with it on an emo­tional level. Even doc­tors, who make de­ci­sions log­i­cally, are more likely to en­gage and be mo­ti­vated if an ini­tia­tive fits with their emo­tions and

val­ues. So, we show data and avoid jar­gon. If we talk about “lean” and “ag­ile” and use words like kan­ban, kaizen, and scrum, it feels like we’re tak­ing away peo­ple’s au­ton­omy. We can con­vey those con­cepts per­fectly well with­out those words.

But don’t peo­ple worry that the pro­grammes are ac­tu­ally about cost cut­ting?

Of course we fo­cus on costs – we have fi­nite re­sources. But it’s about fram­ing. In­stead of talk­ing about waste, we fo­cus on un­war­ranted vari­a­tion in care. Every pa­tient with the same con­di­tion should get the same high-qual­ity treat­ment; when that doesn’t hap­pen, it can be a mat­ter of life and death. Vari­a­tion also adds to cost, so re­duc­ing un­war­ranted vari­a­tion in­creases care and re­duces cost. We see more suc­cess when we frame things in terms of our mis­sion, which is care.

How do you start an ini­tia­tive with­out los­ing the gains of the pre­vi­ous one?

Four years ago, we did a crowd­sourc­ing ex­er­cise in which we asked col­leagues about the big­gest bar­ri­ers to change. The most com­mon an­swer was “con­fus­ing strate­gies.” Peo­ple said that when a new ini­tia­tive, tar­get, goal, or fo­cus comes along, they don’t know whether it’s more im­por­tant than the pre­vi­ous one. We have to find ways to con­tinue the jour­neys we’ve started by sus­tain­ing peo­ple’s en­ergy while cre­at­ing space for new things. Man­agers and lead­ers must make sense of those things and re­duce am­bi­gu­ity.